Cancer surgery delays brought on by the COVID-19 pandemic could affect long-term survival for many patients, a new Canadian study shows.
Among the challenges faced by Canada’s health-care system more than two years into the pandemic is the backlog of delayed surgeries and procedures that could take years to clear.
The new Canadian Medical Association Journal (CMAJ) study adds to the growing body of evidence examining the unintended consequences of the pandemic on patients with cancer.
“Although de-escalation of cancer surgeries during the pandemic may be required to protect vulnerable populations and create health-care capacity, these slowdowns are associated with a risk of unintended harm,” the study, published March 21 in the CMAJ, says.
Using real world data on cancer care from 2019 to 2020, the research examined the impacts of delays on those awaiting surgery before and during the first six months of the pandemic, with a focus on the province of Ontario.
The simulated model population comprised 22,799 patients waiting for cancer surgery before the pandemic and 20,177 patients during. The mean wait time for surgery before COVID-19 was 25 days, which was bumped up to 32 days during the pandemic.
The study looked at those receiving non-emergency surgery, including those with breast, gastrointestinal, genital and urinary, gynecological, head and neck, liver and gallbladder, lung and prostate cancers, and found that during the first half a year of the pandemic, a total of 843 years of life of cancer patients across Ontario could be lost as a result of delays.
“Although our model was a simplification of the diverse disease trajectories,” Dr. Kelvin Chan, the senior author of this study and a medical oncologist at Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, said that “the notable differences in survival by disease site” draws attention to the “need for measures of surgical prioritization during pandemic-related slowdowns.”
At the beginning of the pandemic, Ontario, like other provinces, asked its hospitals to ramp down elective surgeries so the province could prepare to curb the spread of the COVID-19 virus.
During the rapid spread of the Omicron variant, the province again put non-urgent surgeries on hold before resuming them at the end of Jan. 2022.
A report by the Ontario Medical Association last month found the backlog in Ontario alone was more than one million surgeries. Before Ontario’s second surgery shutdown, the association estimated it would take over two years to clean the backlog.
The new research estimated that 4,639 patients were on the waitlist for surgery on the first day of the pandemic in Ontario. This included 158 patients with liver and gall bladder cancers and 1,619 patients with genital and urinary cancers.
The study also estimated that 140 new patients would be added to the surgery wait list every single day.
“The health-care response to the COVID-19 pandemic in Ontario was driven by an intention to protect vulnerable populations of patients and reserve adequate health care resources to manage a potential surge of patients with COVID-19,” the study said. “We have shown the unintended consequences of this policy intervention in Ontario.”
“We showed variation in loss of life-years across cancer disease sites.”
With a hypothetical 60 per cent reduction in operating room resources for cancer surgery in the first six months of the pandemic, wait times increased up to 21 days, compared to pre-pandemic, the study found. This translates to an overall total of 1539 years taken off the lives of cancer patients across the province of Ontario.
Cancers with a higher risk of progression, like liver and gall bladder and head and neck cancers, were among the largest variation in life-years lost per patient.
READ MORE: Half million less surgeries performed since pandemic began
Another study from the beginning of the pandemic, in part completed by Western University professor Janet Martin, projected that 28.4 million surgeries worldwide could be cancelled of postponed in 2020 alone.
Each additional week of cancellation could result in a further 2.4 million cancellations, the research said.
Over half a million fewer surgeries were performed across Canada during the first 16-months of the pandemic, compared to previous years, a Canadian Institute for Health Information report from the end of last year suggests.
About 560,000 fewer surgeries were performed between March 2020 and June 2021 compared to the previous 16-month period through 2019, according to health data compiled and analyzed by CIHI for the report.
Ontario had a 76 per cent decline in surgeries in April 2020 compared to a year before — the sharpest drop of any province or territory in that hard-hit month.
Manitoba’s delay grew to over 161,000 diagnostic and surgical procedures as of mid-February of this year, according to Doctors Manitoba, a group representing the province’s doctors.
In Quebec, hospitals across the province had to reduce surgeries by about 50 per cent at the height of the Omicron wave. Dr. Francois Marquis, the chief of intensive care at Montreal’s Maisonneuve-Rosemont hospital, said Friday it will take months for the hospital to bring surgical waiting lists to their already daunting pre-pandemic levels.
“The hospital is not working full speed,” he said. “There are not enough surgeries, there are not enough patients being admitted. You still have rooms that are closed because we don’t have enough nurses and (respiratory therapists).”
Marquis says catching up is a challenge, given the number of nurses that have retired, left the field or transferred. But by working efficiently to streamline procedures, he’s happy to say that the hospital hasn’t cancelled a single surgery recently.
Last week, the Canadian Medical Association (CMA) and some 40 organizations representing health workers called for urgent government action to address issues facing the ailing system.
“While governments and Canadians are hoping to move past the pandemic, an exhausted, depleted health workforce is struggling to provide timely, necessary care to patients and make progress through a significant backlog of tests, surgeries and regular care,” CMA president Katharine Smart said in a statement following an emergency meeting.
“Careful management of health care resources is critical during times of resource constraint to mitigate unintended consequences,” the study echoed.
— With files from the Canadian Press